Kara is the co-founder and Director of Nutrition for NutriSense, a full-service health education company specializing in the cutting edge health and medical technology of Continuous Glucose Monitoring (CGM).
What was previously a surgical procedure to implant a sensor is now a simple patch on the arm that delivers real-time glucose values to your smartphone. This amazing technology transcends the minimal insights offered by a one-time fasting blood glucose value obtained during a routine blood test. Regulating glucose (and consequently, insulin production) over a lifetime is believed to be one of the most important ways to steer clear of epidemic metabolic disease and improve your health and well-being.
In this show, Kara describes the three key blood glucose attributes that are critical to health. Besides striving for a fasting blood glucose value under 100 (Kara wants to see you under 90!), it’s also important to have a tight glucose variability and a strong ability to quickly lower post-prandial (after a meal) glucose back to your baseline in a short time. Perhaps the greatest attribute of Apps like NutriSense is the power and motivation it gives to the user to promote behavior modification. When users apply a patch for a two-week journey into the glucose values, they have a Registered Dietician coach at their service to guide them with 1:1 support.
We also discuss some amazing insights provided by the App. Kara reacted quite differently to bananas versus sweet potatoes. Indeed, our genetic particulars and perhaps our gut microbiome goes far beyond the guessing game of the glycemic index and helps you make the best choices. Mia Moore used the CGM to facilitate a remarkable improvement in glucose in only two weeks. Coming on the heels of extreme work hours and less activity, she put the patch and went on a two-week hiking binge and increased daily fasting and ancestral-aligned meals. She moved from a pre-diabetic reading at the doctor’s office (during a hectic work period of less activity) into the exceptional metabolic health category with extremely tight glucose regulation and post-prandial glucose control. I noticed an extreme glucose spike in conjunction with workouts, which is actually expected and desirable. I also obtained the insight that combining high-intensity sprint workouts with extensive daily fasting and carnivore-ish low carb intake at meals with being in the advanced age groups while trying to perform these magnificent sprinting/high jump workouts could represent an excess of stressors. Kara provides an excellent description of the so-called, “metabolic insulin resistance” experienced by superfit, low-carb intake athletes. The body produces insulin so minimally that cells become desensitized to insulin signaling. This is not a disease pattern like a high carb, inactive person developing pathological insulin resistance, but there is an argument for the strategic intake of nutrient-dense carbohydrates, especially in conjunction with workouts and especially for older dudes trying to push and sometimes exceed their athletic capabilities with tough workouts. Relatedly, you may have noticed the @CarnivoreMD Dr. Paul Saladino touting his strategic binges of honey (technically carnivore, after all) to fine-tune insulin sensitivity.
If you have concerns about your glucose levels and consequent disease risk factors, getting a CGM going is absolutely essential. If you are metabolically healthy and just looking to optimize your food choices, exercise routines, and insulin sensitivity, you will love the self-quantification and accumulation of insights that you can carry with you over the long term. Enjoy a fascinating show with Kara and learn more about her operation at NutriSense.io
You can get a patch sensor to put onto your arm for continuous glucose monitoring with a readout directly into your smartphone. [01:35]
How did Kara get involved? She saw the need to address metabolic health from an early stage. [05:50]
When using these monitors, you get support from dietitians and educational personnel. [07:42]
Glucose is influenced by eating carbs or not, and also your activity level, stress, sleep…all these factors. People respond to food uniquely. [11:07]
There’s a lot of research to show that microbiome composition is a primary determinant of those various glycemic responses. [14:29]
What are the goals and main things we are looking for? How high is the glucose getting? [17:11]
The connection between glucose levels and cardiovascular is really strong. [23:42]
If we have a bunch of fat in a standard American meal, it slows down digestion. Then glucose takes a long time to go through the system. [25:07]
The damage is worse on the longest-lasting cells and tissues in the body. [29:48]
Is there any concern about not getting these occasional glucose spikes? [32:14]
For people on a low carb diet, there can be a problem because your body says, “I’m not getting enough carbs, so I have to increase the glucose I make.” [34:42]
It’s important to look for a strategy where there is strategic inclusion of carbohydrates to fine-tune that insulin sensitivity. [37:42]
Sometimes when we’re putting too much stress on our body, then trying to fast, we might see some glucose increase. [41:38]
Going on walks after a meal or walking in a fasted state is one of the easiest ways to make a quick turnaround. [43:34]
Our brains are hardwired to want instant gratification. [45:54]
After an argument, the glucose spiked high because of the fight or flight response. [48:45]
If you are feeling crappy after a particular meal, it indicates that the glucose is circulating around and the insulin is coming and it’s taking too long to get back to feeling normal. [50:11]
Without this glucose monitor on your arm, you can still learn a lot from journaling how you feel. What you ate. Which components of my meals are making me feel cruddy. The time of day you are eating makes a difference. [51:09]
There is a decided difference between the foods and how they are processed. [53:14]
It might take one to three months to gather all the insights you want on your health journey. [55:34]
The people who are using NutriSense present a lot of data. What are the trends from the client demographic? [56:17]
For many years, we have been told to eat carbs (Standard American Diet). The new information we have now needs to become common practice before it’s too late. [57:44]
What does it cost to get started with NutriSense? [01:02:00]
The support you provide with this program is exceptional. [01:03:55]
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Get Over Yourself Podcast
Brad (1m 35s): Hey listeners, it is time for a fascinating show with Kara Collier. She is the director of nutrition for Nutra sense, which is a health education company specializing in the extremely cool ultimate cutting edge health and medical technology of continuous glucose monitoring. Yes, for the first time in the history of humanity, you can get a little patch sensor put onto your arm and it will give a continuous readout of your blood glucose levels for a period of two weeks, all the data goes right onto your smartphone. Brad (2m 16s): You actually put your smartphone up against your arm and perform a scan a few times a day or more times if you want, but it will record the data every 15 minutes and put it into the beautiful app that they’ve designed at NutriSense where you have all this feedback and data. And you’re looking for your spikes that occur in response to meals, how well you control your blood glucose overall on a 24/7 basis, but also your response to meals, the particular content of your meals, how certain carbohydrates affect you of course. Also how things like workouts, your life stress levels and all that great stuff play into this hugely important marker that previously we’ve only been able to get a very basic and perfunctory information from doing the fasting blood glucose reading. Brad (3m 6s): When you’re doing your annual exam at the doctor’s office, or perhaps you’re buying a blood meter like the Precision Extra, like the keto enthusiasts will test their blood ketones and their blood glucose. And I’ve been doing this for several years, but let’s say I do it a couple of few times a week, or maybe every day when I’m deeply immersed in a ketogenic experiment, but it’s not part of my daily life. And it’s a hassle and it’s inconvenient and I don’t have that continuous readout and that constant feedback. I think the greatest potential for this type of technology is in the area of behavior modification. So now you have quantifiably the immediate result of doing healthy lifestyle habits, like, and not finishing the entire bowl of ice cream or getting up after dinner and walking around the block. Brad (3m 54s): And when you hear the recommendations in theory, the research that we cite in our recent book Keto for Life, that if you just take a simple walk after dinner at a very slow speed for not very long, like a 15 minute walk or a 30 minute walk at one mile per hour, I believe the research was. So it’s just a really casual stroll. You can mute the insulin response to your meal by 50%. That’s pretty awesome. But if you can look on your smartphone in real time of this actually happening and, you know, clearing that blood glucose more quickly. Oh boy, what a fantastic path we’re on. So let’s listen to a great show from Kara Collier of NutraSense dot I O. That’s N U T R I S E N S E dot I O. Brad (4m 37s): Go check it out and get started yourself with your CGM director of nutrition for NutriSense. I’m so excited to talk to you. This has been an incredible journey into the cutting edge of health. When I first found you guys and got my CGM going all kinds of insights to discuss for the listener in hopes that they’ll try out this amazing new technology. But first things first. You just made an incredible move in your life to an exciting new city. I don’t know if people have heard of it, Austin, Texas Kara (5m 9s): Yeah, definitely. So I just moved to Austin from Washington, DC. Quite a dramatic change in culture and geography between the two cities, but super excited to be here. It seems like everyone is also excited to be here because everyone’s moving to Austin, but we’ll see how busy it gets. Brad (5m 26s): Yeah. I’m wondering if you’re out there jogging on Town Lake and like every fourth person has a patch on because it’s the coolest epicenter of, you know, health and healthy living in the whole world. Kara (5m 38s): Yeah, it definitely seems like all the nutrition folks, the nutrition circle are migrating towards Austin and a lot of startups scenes here in that space. So it’s an exciting place to be. I’m excited. Brad (5m 50s): How did you get involved with NutiSense? And I guess I can let you roll out and, and talk about what the company does and where things stay on now with this amazing technology. I’m familiar with it from several years ago, talking to Peter Attia and if I’m not mistaken, he had to have a surgical procedure to implant a CGM into his abdomen before they had the useful consumer technology. Kara (6m 15s): Yeah. The technology has come a long way in a short amount of time. So I’m a little bit about my background and how I came to NutriSense first. So I’m a registered dietician and I originally started my career in the hospital systems specifically in the ICU critical care nutrition and my experiences in the real world healthcare system really spend where I am now and my interest in metabolic health and preventative health because so many people coming in and out of the hospital are there because of lifestyle related chronic conditions that are really stemming from poor metabolic health, insulin resistance. And it’s a lot of suffering and resources and energy that felt unnecessary. Kara (6m 59s): And that was very frustrating for me. So I teamed up with two other co-founders and we started NutriSense to really drive at that problem we’re seeing in the real world of, you know. Everyone’s not taking care of themselves and then we’re seeing these consequences way down in the road. So we wanted to address metabolic health from an early stage. So at NutriSense we are utilizing these continuous glucose monitors specifically in a non-diabetic population. So traditionally this technology is available by prescription for diabetics. So it isn’t considered a medical device in the United States. Kara (7m 40s): And it’s really mostly prescribed for Type 1 diabetics who are insulin dependent and it’s sometimes prescribed in Type 2 diabetics, not even that often in Type 2 diabetics, only about 30% of Type 2 are wearing a CGM. And then you’re not a Type 2 diabetic and you just want to optimize health and maybe prevent diabetes. It would be very hard for you to convince probably most doctors to write your prescription. Obviously there’s nuances to that someone like Peter Attia or someone like that is clearly writing them for their patients, but generally it’s, they’re hard to get. So we wanted to reduce that barrier to entry, allow these devices for everyone because we really believe the power and the data and the power of monitoring glucose. Kara (8m 24s): And so we give you the device, our app, and then dietician support. So we include support in the package because I’m really a firm believer that data without any sort of signal or direction is just noise, right? So we’re really trying to create some signal there. It’s not the dietician. Isn’t there to, you know, make you follow a specific plan. It’s not Weight Watchers or something where it’s just there to be sound sounding board for evidence. And to help you point out things in your data and, you know, maybe hold you if you need that. But it’s more so to be able to direct that what’s happening in the data because our bodies can be confusing and sometimes there’s a lot going on with glucose data. Kara (9m 6s): So they’re there as a real person support who are trained in interpreting glucose and other data points. So that’s sort of what we’re doing in a nutshell, like you said, the technology of continuous glucose monitors come a really long time in a short amount of short amount of time. So it used to be, they were really, really expensive and very invasive and now they’re becoming easier to apply. They last longer. They used to only last for two days and now they last for about two weeks. So I can only imagine that that’s going to continue to grow and be cheaper and less, maybe more discreet, less medical looking. There’s a bunch of companies now trying to create these devices. Kara (9m 47s): So I think we’re only just at the cusp of what the potential is there. Brad (9m 52s): Oh, speaking of potential for the average person just to optimize health, not even in pre-diabetic risk category, but certainly anyone who has any concern whatsoever should be on this thing tomorrow. As soon as you listen to the show, I’m hoping you’re going to, you’re going to pop for the service. And I do have to put a plug in for the, the support aspect cause I was blown away. I mean, when you sign up for this two week journey, the hand-holding is, is, is absolutely spectacular and you get such a tremendous education. I got to think some of it must’ve been cut and paste because these answers came in two minutes and they were so lengthy and detailed. Brad (10m 32s): And just with this incredible big picture overview of what was going on when I’d ask an innocent question, and that was definitely the high maintenance client of the 2020 award for, you know, all the peppering back and forth. But the, the, the support that the customer gets, and I think the educational value is tremendous. And then, you know, maybe you’re not going to have one on your arm for the rest of your life nonstop. Although some people probably highly recommend it. But even when your two weeks is over the insights that you take forward are so helpful for, like you said, behavior modification, I think is the big potential here. Kara (11m 8s): Yeah, absolutely. I agree. So I’m clearly in the camp that I think everybody should wear at least one of these. So the device slats 14 days item. Yeah, because you can learn so much, like, of course it is useful if you have insulin resistance or pre-diabetes or any sort of health condition, to be able to figure out what you need to tweak and do to improve and reverse that disease. But if you’re a perfectly healthy person, no signs of insulin resistance, there is still so much you can learn from seeing data from your own body. Glucose is not only affected by eating carbs or not. It’s not just telling us if you’re diabetic or not. It’s influenced by your activity level. Kara (11m 50s): It’s influenced by stress and sleep all of these different factors. And then something that’s very important to keep in mind is that we all have really unique responses to food. The variability between people for the same healthy whole food is not the same from person to person. So I think this is a big insight for a non-diabetic a healthy, non insulin resistant person. Is just learning which foods you respond better to. So for example, between me and I think you worked with Carly, who’s another dietician on my team. We’re very similar in like our height, weight, activity level, but we respond to different foods very differently. Kara (12m 31s): So I have a we’re Brad (12m 35s): working on it now, Seattle, Kara (12m 37s): which is also a great, yeah, so she, like, I respond, I barely have any sort of glucose response to bananas, but for her bananas lead to a big glucose response and same with, I have massive spikes to sweet potatoes whenever I eat them, but she barely moves at all. We all just have unique responses. So I see this across the board is not, everyone’s going to respond to the same food and the same exact way, the end of the day, where this unique compilation of genetics and epigenetics and microbiome determines glucose response a lot too. And we just don’t know necessarily what foods are more optimal for you. If you’re not measuring it, it’s hard to tell unless you have some sort of data to show you, Brad (13m 22s): Well, that’s a really puzzling little tidbit there from you and Carly because we’ve, you know, known about the glycemic index and go in and look at that chart and see which carbs are more favorable and which aren’t, but I guess you guys are furiously researching the possible consequences of why banana’s no big deal for, for you. And it is for someone else and then vice versa for the sweet potatoes. And you mentioned a few things quickly. I mean, is there some emerging research that there’s the, the genetics, the blood type, something like that, that’s making it? Brad (14m 6s): I mean, the thing I’m concerned about is the unfavorable response. When I’m thinking that a sweet potato is vastly better than a banana or what have you, but the, the data proves otherwise. And I also think you had some strange examples like broccoli or some, you know, something in the leafy green family that everyone by and large thinks as a minimal glycaemic problem, but not so for certain individuals. Kara (14m 31s): Yeah, it does vary quite a bit. And so pinpointing exactly why it’s probably not one reason. There’s a lot of research to show that microbiome composition is a primary determinant of those various glycemic responses. So it doesn’t necessarily mean one microbiome is better than the other. It’s we have a diverse species of bacteria living in our gut and they help to break down these carbohydrates and they help to reduce that glemic impact. But you might have a certain predominant species that breaks down a certain type of carbohydrate better than somebody else. There is a research study. So predict two is a different company that mapped out everyone’s microbiome and then compare their glucose responses to what the CGM and they were able, you know, they, it was a good study. Kara (15m 21s): They have a really large number. I can’t remember the exact details at this moment, but they were able to then predict how you were going to respond to a food based off of your microbiome mapping with enough of this automated like analysis, which is really fascinating. So for some people, they were going to show, they knew that you won’t spike from ice cream, but you’ll spike from chocolate or something like that. So they were able to predict, and they were measuring, you know, a bunch of other factors and microbiome composition was the largest predictor of how you might respond. So it’s, it is really interesting trying to figure out exactly what’s going on. There is probably much more complicated than just like one simple answer, but it’s definitely true that we don’t all respond well to the same exact thing. Kara (16m 7s): And so now I know, you know, I’ve tried enough foods cause I’ve worn enough CGMs that I know exactly which carbs I’m going to respond well to on a consistent basis. And exactly which ones are just like, not worth it. Like I don’t even like them that much. I don’t need to, you know what I mean, eat the one that’s spiky me way more than the other one. Like even just comparing and with glycemic index. It doesn’t always, so glycemic index is done on large population scale was when people eat this, how does their glucose respond on average? So that’s telling us how most people respond. It’s maybe a good general rule of thumb. Most of the time people respond better to berries than they do to pineapple. Like it’s a higher glycemic index, fruit pineapple. Kara (16m 47s): So it’s a good general rule of thumb, but there’s all these variances between that. So for saying the average person responds to this. That means, you know, 50% is maybe lower and 50% is maybe higher. So we’re seeing that, you know, when you’re actually measuring your own, who knows where you lie on that spectrum. So it’s a good general rule of thumb, but it’s certainly not an end all be all to decide which carbs are best based off of glycemic index scale. Brad (17m 13s): I guess we should. I’m so excited as we, as we converse about all these things, but I think maybe we should back up for the listener. Who’s not familiar and discuss those wonderful big picture presentation that you did when I first started my journey. Welcome. And then here are the, the goals and the main things we’re looking for. And we’re mostly familiar with our fasting blood glucose that we get at the doctor once a year, that one snapshot in time, which obviously if the number is high, it’s a, it’s an indicator that you have some metabolic issues, but it also could have been a morning where you got into a traffic jam and had a temporary spike, or, you know, I’ve known for years using the blood meters that exercise prompts, these huge spikes in glucose, which by and large is desirable or necessary to complete the workout. Brad (18m 5s): But I like when you talked about variability as being possibly the highest objective, so maybe you can cover kind of the different things you’re looking for besides just the, the, the raw number at any given point in time. Kara (18m 19s): Definitely. Yeah. So as you mentioned, if we’re going into our doctor’s office to assess glucose, you’re pretty much just going to get the fasting glucose level, which is just that snapshot in time. And even just a nuance in there. Traditional metrics are saying that a value below a hundred is optimal, but I’m really looking for something between 70 and 90 as that sweet spot. So there is some evidence that once you start to get to the like 90 to a hundred range consistently that you have an increased risk for insulin resistance, different disease states. So that’s just a separate nuance of, I have a different threshold of what I consider auto versus traditional standards. Brad (18m 58s): We better stop there because that’s, that’s a huge deal. And that’s true for many other blood values. My main man, Dr. Ron Sinha was, you know, talking about how, Oh, triglycerides under 150 is by and large, the, the threshold and the cutoff point. He says, I want to see people under a hundred because the average and the norms that we’re looking at are basically a, the fattest, sickest population in the history of humanity. So we don’t want to be in the normal range. We want to be exceptional. And so that I heard that they’re kind of inching that threshold up over a hundred, because there’s so many people, tens of millions of people in the pre-diabetic category that now they’re saying under 110 or under 120 is okay. Brad (19m 43s): Is that a rumor or where Kara’s world and the medical establishment? Kara (19m 52s): Yeah. I don’t know exactly where they’re moving. Nobody is necessarily telling me how they’re changing the guidelines, but it used to be that the threshold was 110, maybe like 10, 15 years ago. And they’ve moved it down to a hundred. So I was hoping that that meant that eventually they’ll see the evidence and move it down to 90. I hope they don’t then go back and move it back up to on 110. We’ll see. But you make a very good point where it’s not just fasting glucose, where we’re seeing the difference between a reference range and optimal values. If you look at the history of the liver function enzymes, so like your alt EFT, these have slowly, the reference range has grown year over year. Kara (20m 32s): As we’ve become an unhealthy society. We have alarming rates of fatty liver, and now what’s normal on a reference range is, is not even close to what was normal 10 years ago. So we really do have to dig into this deeper. If you just get labs back and you’re not getting any sort of interpretation, they might look all in the green and check marks, but that doesn’t necessarily mean everything is an optimal range and agreed with the triglycerides. I like to see it below 90, and I like to see HDL above 50. And that’s what I look at the most on a lipid panel. So that’s a whole different topic, but we’re looking at optimal glucose values. So there’s fasting glucose, and then you might get a hemoglobin A1C from your doctor. Kara (21m 15s): Again, that’s not a lab test I love because it’s just telling you your average glucose. It doesn’t tell me anything about how high you’re getting, how low you’re getting, how much you’re swinging around. If we think about it inherently, it’s just measuring average. So that’s semi valuable, but it’s not the whole picture at all. And the other thing to keep in mind about hemoglobin A1C is that it’s measuring your average glucose on your red blood cells. So we’re assuming with that test that your red blood cell lives for 90 days, but a lot of people don’t they’re shorter or longer, which is going to skew the results of that test. So it’s very common for it to come back as not a very accurate representation of your average glucose values. Kara (21m 57s): So I don’t love like harping on A1C either as an optimal test. So then it’s okay, what are we looking for in your CGM data? And of course, we still want to see what is your fasting glucose in a fasting state. But what we really want to focus on is glycemic variability and your postprandial glucose responses. So postprandial just means after eating and that’s where a lot of insights can be derived. So we’re not in a fasted state all day. We want to see how is our body responding to the food we’re putting into it. So we’re looking at two different things in a fed state. The first one is how high is your glucose getting? Kara (22m 37s): We want to see glucose below 140 most of the time. Brad (22m 42s): So this is about postprandial. So no matter what, even if I have two hot fudge sundaes, that means it’s a bad idea. If I, if it’s spiking beyond that. So like 140 is kind of your cap. And I guess you’re expected to hit that after a robust meal, especially if you’re including carbs? Kara (23m 3s): Yeah. And so we expect our glucose to go ups on some, if we’re including carbohydrates, a lot of people want to see a completely flat line on their glucose. And I don’t think there’s necessarily an added benefit to never having glucose move. We just want to keep it within, you know, static ranges and we don’t want it to see moving all day long. We don’t want like a big up and down all day long. So let’s say you’re eating a meal. You have some carbohydrates, glucose goes up. We want to keep it below that 140 threshold. Cause when we get above that on a frequent repeated basis, that spike that glucose value in your blood vessels is damaging to the actual endothelial tissue. Kara (23m 43s): So this is where the connection of glucose levels and cardiovascular disease is really strong. So each time you have a large spike in glucose, that’s damaging to your blood vessels. So there’s, we want to keep that below a certain threshold, but we also want to look at what the shape of your glucose response looks like. So let’s say you only went up to 130. That would be pretty good, but you stayed up at 130 for three hours. That’s a long glucose response. It’s a big area under the curve. And what we know is that that’s a good proxy for our insulin response. So we think about insulin and glucose. Insulin does many, many things, but one of its primary functions is to bring glucose levels back down to normal because the body doesn’t like glucose being high for too long. Kara (24m 32s): It wants it in this tight homeostatic range. So if glucose goes up, we release insulin. It should come back down. That shows that our cells are sensitive to the effects of insulin or not insulin resistant. And that we’re glucose is coming back down to normal. Within two to three hours of eating is what we’re looking for. And if it’s not, if it’s as big prolonged response, that’s showing that the body is pumping out insulin during that whole time to try to get glucose back into normal ranges. So for a healthy person that is not insulin resistant, you might see one of those big prolonged glucose responses. If you just have like a massive all out like standard American diet meal, like you have cheeseburger with French fries and a milkshake, you may not, that may not signal that you’re not insulin sensitive. Kara (25m 19s): It’s just that it was a lot of energy. You’re throwing out your system at once. So we have a bunch of fat in a standard American meal that slows down digestion. So then glucose gets, it takes a long time to go through the system. So you’ll see that big response. You might not get that high, but it’s a larger end of the curve. That’s not a positive response. Where vice versa, maybe you eat what would be considered a healthy whole food based meal and appropriate portion size. Maybe it was like a steak and a sweet potato, but let’s say you’re insulin resistant. You might have a large glucose response and a long glucose response because your cells aren’t very sensitive to those effects of insulin. Kara (26m 2s): And so the is having a hard time bringing glucose back down into normal ranges. So there could be different reasons that that negative response is occurring. But in general, we want to see how high is your glucose going? And is it coming back down to pre-meal glucose values within two to three hours of eating that general shape of the curve. Brad (26m 20s): So getting that glucose back down to normal implies that you’re insulin sensitive. So the insulin is still coming into the bloodstream, but it’s doing a job quickly and efficiently. It doesn’t have to work for three hours. It can, it can punch it out in one hour because your cells are so receptive to the signaling of insulin. And I guess that’s that, that’s why that’s such important tracker because insulin resistance, as we know, is the path to metabolic disease, metabolic syndrome, diabetes, heart disease, cancer, all these things. Back to that scary insight that when you spike up over 140 or when you’re up and over 130, 140 for a long time, it’s damaging the, the cell. Brad (27m 5s): How has this taking place? How is that happening? Kara (27m 9s): Yeah. So if we think that in, we could look at it in like a zoomed in level, and then we can also look at it at like a larger level. So the damage is mostly done to the micro microvasculature of the body. So for thinking about each glucose spike, there’s this concept of glucose toxicity where too much glucose in the blood vessels in circulation is toxic to our systems. So each large spikes, so maybe you’re hitting 160, but it comes back down to normal. That little spike can cause some microvasculature damage, which releases inflammatory molecules and causes some oxidative stress. Kara (27m 52s): And then the body should come in and correct that it can handle, you know, the inflammation is occurring so that the body knows to correct it and it works it through. So if you have a glucose spike, that’s really high every once in a while, it’s okay. Like your body’s going to be able to correct this. Like it’s okay. You know, some people that have a spike one time and they’re like, like, is everything done? I like break. And my insulin resistance. It’s like, it’s okay. Every once in a while we can have something that’s basically posting your body can fix it. But it’s about repeated exposure. If every single day for breakfast, we’re having a cereal and banana and we’re having a glucose spike to 180 and you’re creating that damage and oxidative stress every single morning, that’s going to accumulate in your body’s going to have a hard time, always correcting that and getting back down to normal. Kara (28m 42s): So that’s where we see repeated damage. And we start to get this negative feedback loop. And that’s where you can kind of look at a more zoomed out level. Is these multiple offenses when we get stuck in this negative feedback loop, that’s when we start to see insulin resistance really drive up and we know insulin resistance, doesn’t just cause diabetes. As you mentioned, it is a primary driver for cardiovascular disease risks for neurological problems like dementia, or kidney disease, hormone dysregulation. It’s driving a lot of these metabolic problems. So when we get in this negative feedback loop, that’s where we see some serious issues and it’s like that with glycemic variability so those big swings up and down that you miss when you’re just measuring average glucose or fasting glucose, you, you can’t see that that damage is occurring and that’s an independent risk factor for these problems like cardiovascular disease risk. Kara (29m 43s): If that makes sense. Brad (29m 45s): Sure. And we’re struggling a little bit to hang with the science. I love Dr. Cate Shanahan’s insight on this, this concept, you know, when you’re eating the cotton candy or making a pineapple smoothie and the, your fingers get sticky because you’re dealing with the, the carbohydrates source, these molecules are sticky. When they’re ingested they go and pick up the important proteins that are the building blocks of the body and the, the controlling, the function of numerous organs and tissues in the body. And I think the damage is worse on the longest lasting cells and tissues in the body. And that’s why you’ve mentioned the eyes. Brad (30m 26s): You mentioned the kidneys, the heart and the cardiovascular system, the skin, the collagen and elastin. And so what do we get? We have diabetics who are known to have vision problems and kidney problems. We have the heart disease epidemic, number one killer. And then we have the wrinkly skin of old people because that collagen elastic is getting worn down by the, the high insulin producing diet, the high, high carbohydrate, probably too much glycemic variability. Geez. Kara (30m 57s): Yeah, absolutely. And there’s a huge link between glycemic variability and just longevity health span because of this sticky glucose, that’s getting stuck to your proteins. So fancy term for this is it’s called ages, advanced glycation. I know how fitting, right. It literally ages you because we’re adding sugar to proteins where we don’t want them to be. So yeah, how I described this as you’re caramelizing your proteins and we don’t want them caramelized, right. We want them to be protein. So when we caramelize them, it’s like you’re cooking it. It’s literally damaging the actual DNA structure and cellular functions of the cells. Kara (31m 43s): And we can only imagine that that’s going to speed up our natural aging system. And it also leads to chronic inflammation because the body’s like, here’s some damage we need to come fix it up. So it sends a bunch of inflammatory molecules to try to clean up. But if you’re doing it day in and day out, like I said, that feedback loop where you’re constantly cleaning up a mess, that’s just growing faster than you can clean it. Brad (32m 6s): So I cut you off as ages is advanced glycation end products. Kara (32m 11s): Exactly. Brad (32m 12s): Right. And that’s the, the, the, the sticky molecules messing up our selling our structure. So, so we now know that we don’t want these frequent and or prolonged spikes. And then we have the extreme health enthusiast like myself, or whoever’s competitive and wanting to look at these numbers. Is there any rationale or any concern about, let’s say not getting these occasional glucose spikes, like eating an extremely low carbohydrate diet and working out and fasting a lot and obsessing with your numbers so that you, you know, you’re, you’re tightening up this glucose variability, to the extent that you get, I believe some people call it metabolic insulin resistance, where you’re producing insulin. Brad (33m 1s): So minimally that now all of a sudden your cells are no longer sensitive to the effects of insulin. So you’re kind of in a, in a, what do you call it? You know, a backward cycle back to a square one that’s maybe not, not optimal? Kara (33m 16s): Yeah. We do see this quite often, especially if somebody is very strict, zero carbohydrate or very low carbohydrate for a prolonged period of time. So I usually start to see this adaptation around like year one of doing very strict zero carbs for, for at least a year. Everyone’s a little different and yeah, it’s this idea of adaptive glucose sparing or physiological insulin resistance. It’s not the same thing as the insulin resistance that comes with diabetes. That’s pathological. It is different. And I think it’s up for debate, whether it’s a bad thing or a good thing, we can dive into it a little bit more. Kara (33m 56s): Essentially the body is super adaptive, right? It’s gonna figure out that you’re never giving me any glucose from food. I’m never getting carbs. So I don’t need to practice this glucose metabolizing machinery. Very often. It’s not going to put out something that’s never getting used. Body is super adaptive and it wants to conserve energy. So instead it lowers those insulin levels because it’s never having to stimulate insulin as much with carbohydrates. And then the muscles start to go into what I call glucose refusal mode. And they start to prefer fatty acids as their primary fuel source. When normally our muscles are utilizing glucose as a primary fuel source most of the time. Kara (34m 39s): So it starts to reject the circulating glucose and prefer fat. So normally what happens in these people is that we start to see a fasting glucose rise over time. So you might have started, you know, when you first switched to very strict ketogenic diet, maybe your fasting glucose was 75. And then a year later, it’s 80. And then three years later was seen at a hundred. And then you’re on year four. And you’re like, it’s 110, what is going on? So this is what we see is as gradual increase in your fasting glucose levels, because the body is like not getting carbs from food. I’m going to increase how much glucose I’m making so that I have enough glucose present for glucose sensitive organs, such as the brain. Kara (35m 24s): It wants to make sure that there’s enough available. So it’s changing its homeostatic threshold, but it’s not the same as if your fasting glucose is rising because you have diabetes. So in these people, we want to double check that everything else looks good, right? That HDL and triglycerides is where we want it. Your fasting insulin is low. You’re having a good body composition, not a lot of fat in the belly area. And if all of those things check out, then we can be more confident that it’s just a natural adaptation and not necessarily a bad thing, or going to increase your risk for disease. But the caveat I will say is that it makes it less, you makes you less flexible to eating carbohydrates. Kara (36m 7s): So let’s say, you know, it’s your birthday and you want to have cake and whatever. You’re going to have a much higher glucose response to that than somebody who is used to burning both fat and glucose as a fuel source because your body hasn’t seen glucose in a year and you just throw a bunch of carbs at it. It’s going to overreact. Fasting insulin is low. The muscles are refusing those glucose. So I’ll see people like this have a big cheat meal and their glucose will rise to 300, 400 because the body just doesn’t know how to process it. And that’s kind of scary. I mean, certainly not a great thing. If you do that really rarely, or you really like sticking to the strict ketogenic diet, it’s probably fine. Kara (36m 49s): But if you want to occasionally be able to eat carbohydrates and your body responds well to that, we might want to cycle in some carbohydrates here and there, so that you’re flexible to both processing fat as fuel and glucose as fuel. So from my viewpoint, I want to be able to have some carbs sometimes. So I include carbs most of the time in my diet, I do some cyclical approaches just cause I want to make sure my machinery for both fuel sources is always primed and ready to go. But that’s the nuance is you can see this adaptation happen. We don’t necessarily believe that it’s increasing your risk for disease, but it’s making you less flexible to a more nuanced eating pattern where you can kind of eat whatever type of carbohydrate or macronutrient you want. Brad (37m 39s): Oh, very well explained. Thank you. And I think I can relate to some of that in my foray into ketogenic eating starting in 2017 when Mark Sisson and I started working on the Keto Reset Diet. So we had to, we had to live the dream baby and walk our talk. And I noticed some surprisingly elevated fasting glucose levels and feeling bombed out after a high carbohydrate meal that perhaps I hadn’t had for a few months. So it definitely makes sense and seems sensible that you’re striving for metabolic flexibility includes giving yourself, which by and large, most people are not averse to enjoying some carbohydrates in the name of health, now and then. Brad (38m 25s): But you you’ve made that clear distinction between the people who are teetering on the edge of, you know, so we don’t want to give, give out hall passes to, to people that already have plenty of carbohydrates or a history of eating carbohydrates. But I also should put in the extra wrinkle here of the fitness angle and athletic training efforts. And especially in my case where I have a few kind of factors to ark in the checkbox. One of them is my advanced age. I’m still trying to do magnificent athletic feats at the age of 55. And I’m on a low carbohydrate diet and, you know, trying to recover from these workouts. Brad (39m 9s): And sometimes if you throw those all together, it could be too many stress factors. And you’re possibly looking at a strategy where a strategic inclusion of carbohydrates to fine tune that insulin sensitivity and become more flexible, could lower the stress impact of everything, including help you recover from workouts faster. And I definitely can feel that myself, that it’s, you know, it’s probably okay to throw in the popcorn and the sweet potato fries, the corn tortillas, and not be so fixated on keeping that glucose continually low and trying not to see any spikes. Kara (39m 49s): Definitely. And I think that’s where a CGM can be very useful because you can, you can play around with this. How many carbohydrates do I need to avoid a big spike, but to occasionally have them in my system. When is it best for me to include those carbohydrates? What type of carbohydrates? So there’s a lot of nuance and we respond differently. The more physically active you are, the better you’re going to be able to tolerate a little bit more carbohydrates in your diet. Especially if you time those carbs after your workout, you’re going to see less of a glucose spike because you just increase your insulin sensitivity by moving your body and moving around and stimulating your muscles. Kara (40m 29s): So there, I think there’s a lot of value to being able to see where can I strategically place in some carbohydrates, if you’re somebody who’s been very low carbohydrate for a long time, I think you can gain a lot of value from kind of playing with that a little bit and seeing where, where you can place healthy, still healthy carbohydrates. We don’t want to necessarily go into refined carbohydrates ever for anybody. We want them to be whole foods, but you can play with that schedule. And like you said, with stressors, so all of these hormetic stressors are work on a U shape curve, right? So things like calorie restriction, carb restriction, fasting, sauna, high intensity exercise, all of these things are good for your body. Kara (41m 17s): You know what doesn’t kill us makes us stronger. Our body’s going to come back stronger, but we are putting stress on our system with all of these changes and too much of a good thing can become a bad thing. So we have to be careful about not going to that U shaped curve or starting to see negative effects from many stressors piled on top of each other. And I see this sometimes with people who are doing all of these great habits, you know, lots of cold therapy, heat therapy exercise, I’m really dialing in their diet. And then they’ll also do extended fast and they’ll see their glucose rise while they’re fasting, when it should be lowering, or it should be static in that 70 to 90 range for the most part when you’re doing an extended fast, but sometimes when we’re putting too much stress on our body, and then we’re trying to put it through this long extended fast, we might see some people’s glucose increase, and that is a signal that we’re under too much stress. Kara (42m 12s): Your body’s in this fight or flight mode. And it’s pumping out cortisol to try to raise glucose levels because it’s feeling a little too many stressors. So that’s something that we have noticed from just seeing so many data. So many data points at this point from different people is that you can add on too many stressors and you can burn your body out. And glucose will rise when stress is occurring. Brad (42m 38s): Well, gee, that’s the beautiful thing of having this little guy on your arm is to keep, keep, keep track of these stressors and how you’re managing them. And I feel like the simple example of getting up after dinner and taking a walk they’ve we’ve referenced research in our book Keto for Life. I forget which exact study, but it was something like a really slow and brief walk can nuke the indolent insulin response by 50% after a meal. So if you’re sitting there looking at your smartphone and watching the numbers, knowing that you can get up and walk around the block and now prove it to yourself and have that data to check in and reference your graph and the software’s incredible people and, you know, the amount of categorizing and scoring and reference points and the ability to write in notes. Brad (43m 32s): So you can remember what you did gives you this remarkable database of, you know, life experience and how to optimize health. So I love that part of it. And especially the most amazing insight. I’ll say my wife wore one for two weeks, and then I wore one for two weeks and I put hers on first because she was coming off an incredible work binge of several years, where she was sitting for at least 12 hours a day and, you know, going crazy. And then right when she got the thing on her arm was vacation time and went hiking like crazy for two weeks straight. We were in Yosemite. We were in Tahoe and every day was extremely active, the exact opposite of her previous life. And she went in two weeks from a pre-diabetic risk category to extremely metabolically healthy, where the meals were having almost no spike in glucose. Brad (44m 22s): And the variability was so tight. The return to baseline the baseline had dropped in two weeks. So, I mean, at the doctor’s office, when you deliver the fasting number, if you go down that route, they’re likely to put you on medication or who knows what, but if so much potential in your hands, and we’re talking about, you know, now hundreds of millions of people across the globe who are at a crossroads where they’re either going to have a steady disgraceful demise into a diabetic and, you know, a pathetic existence for years and decades, or, you know, complete metabolic health where they can build on their success and see it. That must be the most exciting thing for you guys. Kara (45m 2s): Yeah, absolutely. Thank you for sharing that story. It’s so nice to hear it. And it’s so true. We can see these benefits from small, simple changes in a really, really quick amount of time for a lot of people. So, especially if you’re, you know, you’re on the cusp of like prediabetes, we can make such meaningful change in a short amount of time. And one of the easiest ways to do that is just moving your body. Like you said, just going on, walks after meal, going on a walk in a fasted state in the morning. It doesn’t have to be that now all of a sudden, you go to the gym every day for two hours and you’re lifting heavy weights, which I’m all for weightlifting and exercise, but it can be super simple. It can be just moving your body, you know, when the gym’s closed and we were in lockdown, all I had next to my desk was 25 pounds pedal bell. Kara (45m 51s): And just moving every five minutes on the hour, I’ve been sitting in front of a computer for an hour, do a five minute little bursts and then go back down. I was wearing a CGM at the time, and that makes such a meaningful difference. So some really easy changes that we can implement into our day-to-day life that can make a huge difference. And I think what’s so valuable about having the data from anything that’s giving you instant feedback, the CGM, but also things like, or ring or other biometric monitors is that, that instant feedback. So our brains are hardwired to want instant gratification, right? Kara (46m 32s): This is part of the reason that things like social media are so addicting. We love this instant gratification and for a lot of health behaviors that we want to build to create a long, healthy, happy life. They don’t give us instant gratification. So normally, you know, if I’m not getting any immediate feedback from a device, if I’m doing these five minute bursts throughout the day, I might not know if it’s working. It might not be that motivating. Cause I’m like, I don’t know, like I’m doing it because somebody on the internet said it was a good idea. And I thought maybe I’ll try it. But then I stopped the habit two weeks later because I’m like, I don’t really know if it worked or not, not seeing any meaningful change right away, but what’s important about a device like this is that I’m seeing instantly, Oh wow. Kara (47m 17s): That made a huge impact on my glucose values for the rest of the day, brought down my average and it made my response to a meal lower later the day. So I can see instantly, okay, that works. I’ll stick with that. It makes a very sticky habit when you can get reinforcement right away, same with good behaviors and negative behaviors. Right? So something like it’s, you know, there was bagels in the office because somebody brought it in for, you know, whatever reason. And it’s like kind of mindlessly eat it. And maybe my glucose goes to 180 and I’m like, that totally wasn’t worth it. I didn’t even really like the bagel, you know, it was stale, whatever. And so now I have this immediate, immediate feedback that that was a negative response. Kara (48m 1s): It wasn’t worth it. And next time somebody brings them semi stale bagels to the office. I’m not going to do it because I know I had that immediate feedback from the device that it wasn’t worth it. And it had a negative consequence attached to it, which if you’re not getting any data, then I might not know I could eat a bagel every single day. And it might be 20 years before I go to the doctor’s office and it’s out of the reference range. So there’s this huge time gap and you know, your feedback you’re getting. So we’re trying to bridge that time gap and make that quicker because that’s where real meaningful changes and sticky habits start developing. I think that’s part of the huge power in any sort of device that’s giving you immediate feedback. Brad (48m 43s): Yeah. Oh, I want to share the two most shocking isolated insights that we got from Mia Moore using it. And me and for her, the single most dramatic spike, which was so far off the charts that it literally went above the charts was from an argument. So we had a random visitor come by and for a quick visit a friend of a friend, right. And they got, the lady started talking about wearing masks and COVID and contentious how it’s become political and all this. And she wouldn’t stop. She was on a roll. And we were like, yeah, we don’t like talking about it because it’s sort of divisive rather talk about something else. Brad (49m 25s): But it went into this mode where the person wearing the CGM was upset and she like excused herself politely. But then, you know, scanning the things like, Oh my gosh, wait, we weren’t even eating at that time. And it was a higher spike than anything. So that fight or flight response is dumping glucose in the bloodstream. Like nothing else, same with a workout where we’re seeing these spikes. And I’m like, Oh, that’s why because I needed the sugar to do my final set or my another, another group of sprints. And then the other one I was going to mention was one day I was really tired and I had a, a treat of sweet potato fries and I think one bite of ice cream. Brad (50m 7s): So ordinarily that wouldn’t have much of an impact, but the combination of really feeling crappy and late afternoon, and then bingeing on the carbs together produced this massive spike that was out of the ordinary from let’s say I was feeling great and I had some sweet potato fries and one bite of ice cream. Anyway, listeners, those are fun stuff. And the other thing I was going to ask was, okay, you know, 97% of the people listening are going to go get one immediately, but let’s say it takes a week. And so right now over the next week, I think there’s some, you know, subjective ways that we can tell whether we’re excelling with our diet or not, and relation to our glucose variability and the ability to control it. Brad (50m 51s): And I guess one of them would be feeling like crap after a particular meal, indicating that that glucose is circulating around and the insulin is coming in and it’s taking too long to get you back to feeling normal. Is that a, is that a relevant insight? Kara (51m 6s): Yes, definitely. A lot of people will feel it either an energy crash after meals or brain fog, difficulty concentrating just like lethargy in the middle of the day. Those might be a signal that glucose is that glycemic variability. You might be on a glucose rollercoaster. And so a lot of times it has to do with our energy levels and it has to do with just how we can concentrate and how we feel. So those are good subjective experiences to start paying attention to. And you can, even if you don’t have a CGM, if you can’t get one, you can even jot this down, you know, compare it to what did I eat and how did I feel actually pay attention to how you felt? And you could start to see correlations most likely of, okay, whenever I include this one ingredient in my meals, I crash afterwards. Kara (51m 52s): So then you can tweak with that and play with it and see, okay, which, which components of my meals are making me feel cruddy. We don’t want to feel cruddy after we eat, right. It shouldn’t have to be that way. And another big component is when you’re eating your meals. What we see a lot of times with people, I don’t know if you or your wife noticed this is that you can eat the same exact meal late at night. You’re going to have a much higher and prolonged glucose response than if you ate that earlier in the day. So if you’re feeling not great or you’re not sleeping, great. Try to eat your meals a little bit earlier on the line. Then with sunlight hours is a good rule of thumb. If the sun’s out, it might be a better time to eat. Then if it’s dark and middle of the night, it’s not really a great time for our body to be trying to metabolizing food. Kara (52m 37s): We’re not meant to be eating at 2:00 AM. Brad (52m 40s): Oh, for sure. So I’m curious, we talked about your bananas and your sweet potatoes with Carly, but how many foods have you tested yourself and like, what is your database look like in terms of what works for you? And what’s like a red flag food. Kara (52m 57s): Yeah. I’ve tried just about everything that I at least enjoy eating Brad (53m 2s): Come in at whole foods in Austin and like, Oh, there’s the, there’s the tester girl. She buys one of these, one of these, one of these. Yeah. Kara (53m 10s): Yeah, absolutely. I’ve tried just about every fruits that you know is common at least. And every like starchy vegetable, almost all category of carbs. I’ve tried. So ones that I’m like, I don’t even really like it. That much is a huge glucose spike. Like I’m good. Never touching this again would be grapes, pineapple. Quinoa, surprisingly spicy way higher than any other grain. Like white rice is half the response of Quinoa. So I’m like, I will never, I’m good. I don’t even really like it. And then there’s foods that surprise me, like, yeah, bananas were very low. Butternut squash was much lower than sweet potatoes. Kara (53m 50s): White potatoes was much lower than sweet potatoes. So if I’m making a potato choice, you know, at a restaurant and you sometimes get a choice, you often pay more for the sweet potatoes or more for the Quinoa. I’m going to take the cheaper version. Cause I know I respond better to that. And so that’s a big thing. And another is the level of processing of a food. I’ve tried a wide variety of like instant oats vs. rolled oats vs.steel cut oats. And the difference in glucose response is pretty staggering. So from instant oats it’s I increased almost 50 points. So I could go from 70 to 120 where it was steel cut. Oats is on average, only about 20 points increase. So maybe I go from 70 to 90. Kara (54m 32s): So just that level of processing in a food is the same at the end of the day. But we seem to in squashed it and rolled it and pre cooked it. And now it’s just these individual glucose molecules were ready to digest and the instant oats, it’s not the same thing anymore as the original state of the oats. So little things like that, where it’s like, if somebody, you know, if my only option is to say Oh, it’s, I’m going to skip it. I’m good. Like, I don’t want that. I don’t even really like it so I can make these more mindful decisions because of how I know I respond. And if I know I miss my morning workout and I’m going to have to do it in the evening, my breakfast is going to be low carb, just eggs and maybe some greens and maybe avocado. Kara (55m 16s): If I did my morning workout, I might include some more fruit in that meal to have a little bit of carbs in my breakfast meal, because I know my response is going to be much higher if I haven’t worked out any at all in the morning and I’m breaking a fast for the day. So simple things like that, that I’ve switched around. There’s a long list of insights. I think for most people, you know, it takes one to three months to gather a lot of insights depends on where you’re at in your health journey, but it’s about testing different things, trying different foods, different combinations and timing. And then after that, you know, once you really dialed in what works best for you uniquely, it’s all about that behavior change of wearing it. Like we talked about where it’s like, okay, when I have it on, even though I know exactly how I respond to different things, it helps drive that behavior. Kara (56m 1s): It’s more intrinsically motivating to say no to something or to do something. When I have that data right there in my face and you can’t hide from it. So that’s really the biggest benefit once you’ve been wearing it for a while, Brad (56m 15s): You can’t hide from it because you scan, you have to scan every eight hours or you’ll miss some time gaps, but then you got to answer to your graph, baby, you’re looking back going okay, did I execute or not? Well, now you a NutriSense must be getting a ton of data from, from clients. And I’m curious, like what trends do you see in your client demographic? Who is doing this stuff? Is it a bunch of extreme freaks from Austin with toe shoes that jog around town Lake and do a copy, Brad Kearns videos with their bench jumping and weird exercises? Or are we talking about a mainstream America, diabetes risk factor people who are taking matters into their own hands across the board? Brad (56m 58s): What does it look like now? Kara (56m 60s): Yeah. It’s actually about a 50 50 split Brad (57m 2s): 50 50 awesome freaks versus a pre-diabetic? Kara (57m 6s): Exactly. Yeah. So everybody is, is different than, you know, maybe when I was in the ICU, in the hospitals where they didn’t really care at all about what they were doing, at least everybody coming to us, they’re taking their health in their own hands. They want to do something about it. They’re motivated, but about 50% are there they’re really looking for optimization. They’re looking to find that little tweak and to take it to the next level. Whereabouts the other half is maybe they’re pre-diabetic and they don’t want to become diabetic and they’re ready to make some changes. So we see about a 50 50 split, which makes it very fun. Brad (57m 41s): You might have to come up with two different names. Kara (57m 43s): Yeah. Brad (57m 44s): Bad-ass glucose patch.com and then the other one is, you know, get checked, stay healthy. Oh my gosh. It’s, it’s really, it’s amazing. And you you’ve talked about your, the starting point with your journey, which is so fascinating because I believe that the registered dietician educational track is highly steeped in conventional wisdom, a grain-based diet and all that stuff. And now you’ve kind of made a dramatic departure from that. And maybe you could talk to that a little bit, cause it must’ve been, I don’t know, disillusioning, like you describe and your education has nothing to do with what you’re doing now in a way. Kara (58m 23s): Yep. That’s exactly right. So it didn’t really match up to anything that seemed to be working. So traditional dietetics teaching, you know, it’s, it’s the, my play it’s, you know, fill most of your plate with Brad (58m 37s): This is a registered dietician student is going and learning about my plate and the tremendous importance of grains in the diet. And Kara (58m 45s): I play calories in calories, out managing blood sugar. Doesn’t get touched in any regard except for a diabetic. And even that, you know, we’re taught to, to teach diabetics how to carb count, how to count their carbohydrates and match it to, you know, their insulin we’re insulin dosing based off a carb counting. So I obviously very much don’t agree with that approach now, but that was what I was taught. And I think I’m enough of a self-lead learner that when I’m in the setting that I’m applying these things I learned and you see, they’re not really working, not making any sort of meaningful impact. It’s like, okay, I no longer trust what I was taught and I need to learn it on my own. Kara (59m 26s): And it’s all about diving into the research and doing it yourself and figuring out what works and what doesn’t doesn’t. And a lot of those traditional teachings, unfortunately, aren’t getting the job done and it’s frustrating. And I have a team of dieticians underneath me. Now I helped start this company. I was the only dietician. Now we have other coaches who are helping our customers. And so we’re really vetting for, okay. Do you think outside the box, what do you, what do you recommend? And like, you know, screening right away and then teaching them what we’ve learned about glucose. Cause a lot of this was uncharted territory where there’s not a lot of research on what is optimal glucose values for non-diabetic. So we had to learn a lot of this in the beginning, but now we’ve seen enough words. Kara (1h 0m 9s): It’s very clear, but it’s hard to find great dieticians who are thinking outside of the traditional teaching. If anyone is listening to this and they are a great dietician reach out to me. Cause I would love to hear from any dieticians that really, you know, question what we were taught because it’s not helping, you know, we’re not, we haven’t made any great strides with our traditional recommendations. The dietary guidelines for America, I think are extremely skewed and off from what is actually beneficial. We’re recommending 45 to 65% of our calories to come from carbohydrates. I’ve seen very, very few people who can eat that many carbohydrates and have good glucose control. Kara (1h 0m 51s): And that’s what we’re recommending for the average person. The average person is overweight, sedentary and eating refined carbohydrates. Why are we recommending so many carbohydrates then? There’s just a lot of mismatch of what actually works in reality versus what’s recommended. So it is frustrating. I feel a little isolated from the dietitian community, but there are definitely good dietitians out there questioning these practices. So we’ll get there. Hopefully, Brad (1h 1m 18s): Hopefully. I mean, it’s amazing to understand this discord when what we’ve been tryin hasn’t worked. I love the great quote from dr. Doug McGuff author of body by science and he’s a emergency room physician. So he’s right there on the, on the front lines of seeing what’s happening. And he said, look, it’s going to change. Right? Right. Conventional wisdom is going to come around. And pretty soon all dieticians are going to be listening to Kara and she’s going to be doing online education for millions of them, but it’s going to take 20 years, he said. And he goes, I don’t know about you, but I can’t wait that long. And that’s a pretty accurate insight of where we’re headed. This stuff is not going to be around forever where we’re matching insulin injections with, with carbs. Brad (1h 2m 0s): When we have this tremendous movement, that’s going strong. But it’s going to take a long time. So I guess the world lost a wonderful registered dietician in the ICU, but now you’re kicking butt at NutriSense. And I think it’s time to give a really nice plug and describe talk about what does it cost to get started? And you get your, your two week run and the coaching that’s involved and how to, how to participate. Kara (1h 2m 26s): Definitely. So you would just sign up on our website, , NutriSense that IO and you just fill out a quick health questionnaire and Brad (1h 2m 34s): Hi NutriSense.io cause you to yourself to do this. Okay. NeutriSense dot IO Kara (1h 2m 44s): Exactly. Yeah. And all programs come with the dietician support, all programs come with the continuous glucose monitors and our app, which of course tracks everything like you said. And we have programs where it’s just one CGM last 14 days and you just do it once. No recurring payment, no commitment. And that’s great. If you just kind of want to try it out, you just want to check a few things, see what’s going on. That’s $175 one time payment. And then we have monthly subscriptions. So you get two CGMs a month and it continues either month to month, no commitment, or we have three months, six months, 12 month commitment gets cheaper. The longer you commit. And that’s really great. If you want to really play with your diet, you want to try different things, figure out exactly what’s optimal for you. Kara (1h 3m 29s): Or if you have some work that you need to do. So maybe you’re pre-diabetic or insulin resistant. And we want to see changes over time and see that improvements. So you can do the, just the 14 days, or you can stick around for a little bit longer. If you want to see more data accumulated, it’s hard to understand your body completely. In 14 days, it’s a good amount to kind of dive in a little bit, to do a few tests, Brad (1h 3m 55s): Do it like MIa Moore. Come off of that three years of working 12 hour days. So we get a few leftover nonsense and then go on a hiking binge. Right? But didn’t going to try it all in 14 days around the world trip with different cuisine who knows what the possibilities lie or go for a longer one. Hey, that makes sense too. Oh my gosh. And I have to say a lot of offerings say that they come with support. Like when you buy a computer from Apple and you get support and you call and you’re on hold for 45 minutes. But when you’re on this journey, the coaching and the handholding is exceptional. And I’m talking about sending a message through the live chat operation. And then three minutes later, the thing dings with a lengthy thoughtful response to what was going on throughout the time that both of us did it. Brad (1h 4m 41s): So you guys are doing a great service. I don’t know, maybe five years from now, you’ll be so busy that you won’t be able to offer that kind of support. So people listeners jump on it right now while they can hold your hand all the way through. Kara (1h 4m 53s): Yeah. I would definitely agree with that. Jump on it. Now we try to do as high touch and be there as as much, or as little as you want. Some people want to be a little more self led and that’s totally fine. Some people want me to check in every single day and say, make sure that I went to the gym today. It’s like, okay, I can be there if you want me for that accountability as well. Eventually you have to be able to learn how to do it yourself. But if we’re getting started and building habits, I can that accountability partners. So people utilize the service in a wide variety of ways and we’re there to basically meet you wherever you are. And however you’d like to utilize it, Brad (1h 5m 27s): Kara Collier. You killed it. That was a great show. Thank you for taking the time I learned so much and I hope the listeners are highly nthused to go and pull the trigger right now. It’s a life-changing experience. I have to say, no matter what level of metabolic health you’re at, if you’re pre-diabetic, it’s an absolute must. And if you’re an optimizer, Oh my gosh. You’re the kind of person who is spending money on coaching and quality foods. You might as well take the guesswork out of it now and take the next next step. So that is our show. Everybody. Thanks for listening. Thank you for listening to the show. We would love your feedback at email@example.com. Brad (1h 6m 7s): And we would also love if you could leave a rating and a review on iTunes or wherever you listen to podcasts, I know it’s a hassle. You have to go to desktop iTunes, click on the tab that says ratings and reviews, and then click to rate the show anywhere from five to five stars. And it really helps spread the word so more people can find the show and get over themselves because they need to thanks for doing it.